Provider Demographics
NPI:1982706974
Name:GUJRATHI, SUNIL KUMAR (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:KUMAR
Last Name:GUJRATHI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 202
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:877-406-2916
Mailing Address - Fax:
Practice Address - Street 1:4101 WAGON TRAIL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4426
Practice Address - Country:US
Practice Address - Phone:702-942-4123
Practice Address - Fax:702-942-4124
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-23935-02085R0202X
NV132052085R0202X, 2085R0204X
AZ708052085R0202X
NY2356002085R0202X, 2085B0100X
NJ25MA119246002085R0202X
FLME1649212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1982706974Medicaid
P00776738OtherRR MEDICARE
VCL122ZMedicare PIN
NVI72084Medicare UPIN